Varicocele Embolisation
Date issued: November 2024
For review: November 2026
Ref: B-530/LD/Radiology/Varicocele Embolisation
PDF: Varicocele embolisation.pdf [pdf] 214KB
This leaflet tells you about having a varicocele embolisation. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a varicocele embolisation?
A varicocele is an abnormality of the veins that take blood away from the testis. The valves in the veins do not work properly and so the veins become bigger and more obvious, rather like varicose veins in the leg. Embolisation is an X-ray guided treatment, which blocks the enlarged vein from the testis typically using a small coil and allows the veins to shrink.
Why do you need an embolisation?
A varicocele can cause discomfort in the scrotum, which is often worse when standing, exercising or cycling. They are sometimes diagnosed during the investigation of infertility and treatment may help your sperm count. There are a number of ways to treat varicoceles including open groin surgery, laparoscopic surgery and minimally invasive interventional radiology. Interventional radiology uses X-rays to guide a small tube to the vein to block it with only a small 3–4 mm incision in the groin. It is performed as a day case procedure.
Are there any risks?
Varicocele embolisation is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise. There may occasionally be a small bruise called a haematoma around the site where the needle has been inserted into the vein. This will go away in a week or two.
A few patients may experience mild discomfort in the loin or scrotum afterwards which rarely lasts more than a few days.
There is a very small risk of a coil (used to occlude the vein) could migrate to your lungs. If this happens and it cannot be retrieved it is very unlikely to cause any problems other than a cough and mild chest pain for a few days.
Rarely, it may not be possible to obtain a satisfactory position for embolisation, in which case a surgical operation may be offered.
Unfortunately, there is a possibility that the varicocele may come back again. This may also happen after any surgical treatment. If this happens, then the procedure may be repeated, or you may be advised to have an operation.
Are you required to make any special preparations?
A varicocele embolisation is usually carried out as a day case procedure under local anaesthetic. You may eat and drink as normal unless sedation has been discussed beforehand with the referring team/Radiologist.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during varicocele embolisation?
Before the procedure, the Interventional Radiologist will explain the procedure and ask if you have signed a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table flat on your back. You may have monitoring devices attached to your chest and finger and may be given oxygen if required.
The procedure is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves. The skin near the point of insertion, usually the groin but occasionally the neck, will be swabbed with antiseptic and you will be covered with sterile drapes.
The skin and deeper tissues over the vein will be numbed with local anaesthetic, and then a fine tube (catheter) will be inserted and guided, using the X-ray equipment, into position down the vein (testicular vein), which takes blood away from the testis. The Interventional Radiologist will block this vein usually by inserting small metal coils, which look like springs and will remain in the abnormal vein.
The radiologist will inject small amounts of dye (contrast agent) to check the position of the catheter and that the abnormal veins are blocked satisfactorily. Once they are blocked, the catheter will be removed. The Interventional Radiologist will press firmly on the skin entry point for a few minutes to prevent any bleeding.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine. After this the procedure should not be painful.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. As a guide, expect to be in the X-ray department for about 2 hours.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a couple of hours, until you have recovered and are ready to go home.
Take it easy for the rest of the day but you can resume normal activities the next day, although we advise to avoid heavy lifting or straining for a week or two (to allow coil incorporation and reduce risk of migration).
Your varicocele should reduce in size during the coming weeks.
Other Risks
Varicocele embolisation is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Monday to Saturday (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
